Cordina M, Safta V, Ciobanu A, Sautenkova N. An assessment of community pharmacists’ attitudes towards professional practice in the Republic of Moldova. Pharmacy Practice 2008 Jan-Mar;6(1):1-8.
Original Research
An assessment of community pharmacists’ attitudes towards professional practice in the Republic of Moldova Maria CORDINA, Vladimir SAFTA, Ala CIOBANU, Nina SAUTENKOVA. Received (first version):
19-Sep-2007
ABSTRACT* Pharmacy in Moldova is undergoing a period of transition. The professional practice is adjusting to a market-oriented economy from the previous Soviet system. The pharmaceutical sector has been liberalised giving rise to a significant increase in the number of community pharmacies. This has led to some adverse effects on the profession of pharmacy with pharmacists having considerable difficulties fulfilling their professional aspirations and possibly losing confidence in further developing their professional role. Objective: To assess community pharmacists’ attitudes towards their professional practice and to determine their perceived competence in various pharmaceutical activities. Methods: A questionnaire which addressed managerial activities, dispensing activities, pharmaceutical care activities, inter-professional relationships, public health and competence was mailed to 600 community pharmacists who were asked to score the importance and perceived competence for each activity on a scale ranging from 0-5. In the case of pharmaceutical care activities, pharmacists were asked to score their degree of agreement or disagreement as to whether it is the responsibility of the pharmacist to engage in specific pharmaceutical care activities. Results: A total of 370 valid questionnaires were returned giving a response rate of 61.7%. Managerial and dispensing activities were scored the highest both in terms of perceived importance and competence. The more innovative pharmaceutical care activities scored relatively low. Overall scores relating to the importance of pharmacists engaging in public health activities appear to be the lowest of the entire questionnaire. Younger pharmacists between the ages of 22-30 obtained significantly higher scores with regards to the perceived pharmacist’s responsibility in engaging in various pharmaceutical care activities. Respondents who practiced in an accredited *
Maria CORDINA B.Pharm (Hons) PhD (QUB). Department of Pharmacy, University of Malta. Msida (Malta). Vladimir SAFTA. Deputy Director. National Medicines Agency, Ministry of Health and Social Protection. Chisinau (Republic of Moldova). Ala CIOBANU. President of the Association of Pharmacists of the Republic of Moldova. Chisinau (Republic of Moldova). Nina SAUTENKOVA. Manager, Pharmaceutical Policy in NIS, Health Technology and Pharmaceutics. World Health Organisation, Regional Office for Europe. Copenhagen (Denmark).
Accepted: 25-Nov-2007
pharmacy scored higher in the majority of questions. Conclusion: Pharmacists in Moldova appear to be deeply rooted in the traditional approach to the practice of pharmacy pertaining mainly to distributive practice model and are somewhat distant from the other models of practice such as pharmaceutical care, drug information and self-care. Keywords: Community Pharmacy Services. Professional Practice. Moldova
EVALUACIÓN DE LAS ACTITUDES DE LOS FARMACÉUTICOS COMUNITARIOS HACIA EL EJERCICIO PROFESIONAL EN LA REPUBLICA DE MOLDOVA RESUMEN
La farmacia en Moldova está sufriendo un periodo de transición. El ejercicio profesional se está ajustando a una economía de mercado desde el anterior sistema soviético. El sector farmacéutico se ha liberalizado dando lugar a un significativo incremento en el número de farmacias comunitarias. Esto ha producido algunos efectos adversos sobre la profesión farmacéutica que tiene dificultades de cumplir sus aspiraciones profesionales y posiblemente perdiendo confianza en el futuro desarrollo de su papel profesional. Objetivo: Evaluar las actitudes de los farmacéuticos comunitarios hacia su ejercicio profesional y determinar su percepción de competencia en varias actividades farmacéuticas. Métodos: Se envió un cuestionario a 600 farmacéuticos comunitarios a los que se pedía que puntuasen la importancia y la competencia percibida con valores de 0-5 para cada una de las actividades: gestión, dispensación, atención farmacéutica, relaciones inter-profesionales, y salud pública. En las actividades de atención farmacéutica, se pidió a los farmacéuticos que puntuasen su grado de acuerdo o desacuerdo sobre si es responsabilidad del farmacéutico involucrarse en actividades específicas de atención farmacéutica. Resultados: Se recibieron 370 cuestionarios válidos con una tasa de respuesta del 61%. Las actividades de gestión y de dispensación fueron puntuadas las más altas tanto en términos de importancia percibida como de competencia. Las más innovadoras actividades de atención farmacéutica puntuaron relativamente bajas. Las puntuaciones totales relativas a la importancia de que los farmacéuticos se involucren en actividades de salud
www.pharmacypractice.org
1
Cordina M, Safta V, Ciobanu A, Sautenkova N. An assessment of community pharmacists’ attitudes towards professional practice in the Republic of Moldova. Pharmacy Practice 2008 Jan-Mar;6(1):1-8.
pública aparecieron en el lugar más bajo del cuestionario. Los farmacéuticos jóvenes, entre 2230 años, obtuvieron puntuaciones significativamente más altas sobre la percepción de la responsabilidad del farmacéutico de involucrarse en varias actividades de atención farmacéutica. Los respondentes que ejercían en una farmacia acreditada puntuaron más alta en la mayoría de las preguntas. Conclusión: Los farmacéuticos de Moldova parecían estar profundamente enraizados en la aproximación tradicional del ejercicio de la farmacia, perteneciendo principalmente al modelo de ejercicio distributivo y, de algún modo, distantes de otros modelos de ejercicio como la atención farmacéutica, la información sobre medicamentos y el auto-cuidado. Palabras clave: Servicios de farmacias comunitarias. Ejercicio profesional. Moldova.
INTRODUCTION The Republic of Moldova is a landlocked country, with about three million inhabitants, in Eastern Europe, located between Romania to the west and Ukraine to the north, east and south. Moldova was formerly part of the Soviet Union and has been a Newly Independent State (NIS) since 1991. It is a densely populated country with about 54% of the population living in rural areas. Moldova has an economy which is in transition and is thus undergoing reform in various sectors including the health and social sectors.1 Initially following independence Moldova inherited the Semashko health care model from the former Soviet Union, having a highly centralized structure with key decision making and planning taking place in the capital.2 The country’s health care system has since been decentralised into a regional (judet) system and since 1993 pharmacies were allowed to become privatised with most being concentrated in towns leaving a number of rural settlements with no/limited access to pharmacy.3 Currently there is a mixed system of state and privately owned pharmacies.2 Official data indicates that there are about 1000 pharmacies putting the pharmacy to population ratio at 1:3000. Pharmacies are licensed and regulated by The Ministry of Health through the National Medicines Agency. The large scale privatization was set in motion following both an economic collapse and a breakdown in the national prescription system, which led to the state having difficulties in ensuring an adequate and regulated drug supply. The privatization system was meant to address these shortcomings.2 This wide spread liberalisation, has however, led pharmacy to be increasingly seen as a part of the commercial sector rather than a part of a professional system within healthcare. In order to improve access to medicines in rural areas, pharmacy outlets - branches of licensed
pharmacies- staffed by pharmacy assistants were granted permission to operate. In addition local hospitals were allowed to open pharmacy outlets, which are, however, staffed by any available health care worker in the area and not by pharmacists or pharmacy assistants. The privatization of this sector has led to a situation whereby medical doctors have been allowed to purchase pharmacies, usually in the clinic or hospital where they work leading to a situation of conflict of interest where expensive or inappropriate drugs are prescribed to increase the pharmacies’ profit margins at the detriment of the 2 patient. While theoretically under the Semashko model patients received unlimited free services, the provision of modern pharmaceuticals was very limited. Currently the spectrum of medicines available has increased, however, access is still a problem due to costs of drugs placing specific patient groups such those with chronic diseases in a difficult situation as they may not afford to purchase their medication leading to inadequate control of their condition. The World Health Organization through the Special Project for Pharmaceuticals in NIS has drawn up and supported the use of a National Essential Drugs List to encourage rational 4 use of drugs in Moldova. As part of the reform in the health sector, under the law on Evaluation and Accreditation in Health Care (2001) a process of accreditation for pharmacies has been set in motion. Pharmacies in Moldova need to be accredited in order to be eligible to enter an agreement with The National Health Insurance Company for drug reimbursement. The accreditation of pharmacies falls under the responsibility of the National Accreditation Council which sets the required standards based on Good Pharmacy Practice Guidelines (GPP) issued by 5 WHO. At present 338 pharmacies have been accredited by the National Accreditation Council. This is envisaged as being a very constructive step which may lead to further positive developments in community pharmacy. There are currently about 3000 pharmacists in Moldova, approximately three quarters of whom are women. Students receive their pharmacy education at the University of Medicine and Pharmacy in Chisinau where they follow a 5 year university course which precedes a 2 year residency programme. Previously the training was modelled under the Soviet system with the course having a 6 very strong emphasis on chemistry. However as part of the reform in education taking place since 1991 the aim is for the training to be in line with European Union norms.7 Since the late 1990’s the pharmacy curriculum has been revised and now includes more practice based subjects such as pharmacotherapy and more recently topics related to social pharmacy and pharmaceutical care have been included. The problems in the pharmaceutical sector during the period of transition have adversely affected the profession of pharmacy with pharmacists having significant difficulties fulfilling their professional aspirations and possibly losing confidence in further
www.pharmacypractice.org
2
Cordina M, Safta V, Ciobanu A, Sautenkova N. An assessment of community pharmacists’ attitudes towards professional practice in the Republic of Moldova. Pharmacy Practice 2008 Jan-Mar;6(1):1-8.
developing their professional role. The aim of the study was therefore to assess community pharmacists’ attitudes towards their professional practice and to determine their perceived competence in various pharmaceutical activities METHODS A questionnaire was mailed to 600 community pharmacists (one in every 5). These pharmacists were randomly selected from a population of 3000 pharmacists. Pharmacists were given a deadline by which to return the completed questionnaires. The questionnaire consisted of 37 questions divided into 6 sections which addressed various aspects of practice. The questionnaire was translated into Romanian and back translated into English by a third party. The sections addressed were managerial activities, dispensing activities, pharmaceutical care activities, inter-professional relationships, public health and competence. For each of the above areas pharmacists were asked to score, on a scale from 0-5 (1= not important, 5=extremely important) the perceived importance of each activity, they were also asked to separately score their perceived competence (0=not competent, 5=extremely competent), in performing each activity. In the case of questions related to pharmaceutical care activities, which have been 8 adapted from a Odedina and Segal , pharmacists were asked to score their degree of agreement or disagreement (0=strongly disagree, 5=strongly agree) as to whether it is the responsibility of the pharmacists to engage in specific pharmaceutical care activities rather than the perceived importance of each activity. In addition respondents were also asked to provide the following demographic information: gender, age, years’ in practice and if they practiced in an accredited pharmacy. The questionnaire was initially piloted on 15 pharmacists through the Association of Pharmacists of the Republic of Moldova. They commented on relevance, clarity and ease of understanding of questions. These comments were taken into consideration in the final draft of the Romanian version. The data was gathered over a 3 month period between December 2006 and February 2007. Data was entered into to SPSS and analysed using Mann-Whitney U tests, Kruskal Wallis. Spearman’s rho correlation was also used. A p value of 50 92 24.9 Practice Experience (years) 1-10 52 14.1 11-20 104 28.1 21-30 132 35.7 >30 82 22.2 Practice in Accredited Pharmacy Yes 260 70.3 No 110 29.7
There was a significant (p
Original Research
An assessment of community pharmacists’ attitudes towards professional practice in the Republic of Moldova Maria CORDINA, Vladimir SAFTA, Ala CIOBANU, Nina SAUTENKOVA. Received (first version):
19-Sep-2007
ABSTRACT* Pharmacy in Moldova is undergoing a period of transition. The professional practice is adjusting to a market-oriented economy from the previous Soviet system. The pharmaceutical sector has been liberalised giving rise to a significant increase in the number of community pharmacies. This has led to some adverse effects on the profession of pharmacy with pharmacists having considerable difficulties fulfilling their professional aspirations and possibly losing confidence in further developing their professional role. Objective: To assess community pharmacists’ attitudes towards their professional practice and to determine their perceived competence in various pharmaceutical activities. Methods: A questionnaire which addressed managerial activities, dispensing activities, pharmaceutical care activities, inter-professional relationships, public health and competence was mailed to 600 community pharmacists who were asked to score the importance and perceived competence for each activity on a scale ranging from 0-5. In the case of pharmaceutical care activities, pharmacists were asked to score their degree of agreement or disagreement as to whether it is the responsibility of the pharmacist to engage in specific pharmaceutical care activities. Results: A total of 370 valid questionnaires were returned giving a response rate of 61.7%. Managerial and dispensing activities were scored the highest both in terms of perceived importance and competence. The more innovative pharmaceutical care activities scored relatively low. Overall scores relating to the importance of pharmacists engaging in public health activities appear to be the lowest of the entire questionnaire. Younger pharmacists between the ages of 22-30 obtained significantly higher scores with regards to the perceived pharmacist’s responsibility in engaging in various pharmaceutical care activities. Respondents who practiced in an accredited *
Maria CORDINA B.Pharm (Hons) PhD (QUB). Department of Pharmacy, University of Malta. Msida (Malta). Vladimir SAFTA. Deputy Director. National Medicines Agency, Ministry of Health and Social Protection. Chisinau (Republic of Moldova). Ala CIOBANU. President of the Association of Pharmacists of the Republic of Moldova. Chisinau (Republic of Moldova). Nina SAUTENKOVA. Manager, Pharmaceutical Policy in NIS, Health Technology and Pharmaceutics. World Health Organisation, Regional Office for Europe. Copenhagen (Denmark).
Accepted: 25-Nov-2007
pharmacy scored higher in the majority of questions. Conclusion: Pharmacists in Moldova appear to be deeply rooted in the traditional approach to the practice of pharmacy pertaining mainly to distributive practice model and are somewhat distant from the other models of practice such as pharmaceutical care, drug information and self-care. Keywords: Community Pharmacy Services. Professional Practice. Moldova
EVALUACIÓN DE LAS ACTITUDES DE LOS FARMACÉUTICOS COMUNITARIOS HACIA EL EJERCICIO PROFESIONAL EN LA REPUBLICA DE MOLDOVA RESUMEN
La farmacia en Moldova está sufriendo un periodo de transición. El ejercicio profesional se está ajustando a una economía de mercado desde el anterior sistema soviético. El sector farmacéutico se ha liberalizado dando lugar a un significativo incremento en el número de farmacias comunitarias. Esto ha producido algunos efectos adversos sobre la profesión farmacéutica que tiene dificultades de cumplir sus aspiraciones profesionales y posiblemente perdiendo confianza en el futuro desarrollo de su papel profesional. Objetivo: Evaluar las actitudes de los farmacéuticos comunitarios hacia su ejercicio profesional y determinar su percepción de competencia en varias actividades farmacéuticas. Métodos: Se envió un cuestionario a 600 farmacéuticos comunitarios a los que se pedía que puntuasen la importancia y la competencia percibida con valores de 0-5 para cada una de las actividades: gestión, dispensación, atención farmacéutica, relaciones inter-profesionales, y salud pública. En las actividades de atención farmacéutica, se pidió a los farmacéuticos que puntuasen su grado de acuerdo o desacuerdo sobre si es responsabilidad del farmacéutico involucrarse en actividades específicas de atención farmacéutica. Resultados: Se recibieron 370 cuestionarios válidos con una tasa de respuesta del 61%. Las actividades de gestión y de dispensación fueron puntuadas las más altas tanto en términos de importancia percibida como de competencia. Las más innovadoras actividades de atención farmacéutica puntuaron relativamente bajas. Las puntuaciones totales relativas a la importancia de que los farmacéuticos se involucren en actividades de salud
www.pharmacypractice.org
1
Cordina M, Safta V, Ciobanu A, Sautenkova N. An assessment of community pharmacists’ attitudes towards professional practice in the Republic of Moldova. Pharmacy Practice 2008 Jan-Mar;6(1):1-8.
pública aparecieron en el lugar más bajo del cuestionario. Los farmacéuticos jóvenes, entre 2230 años, obtuvieron puntuaciones significativamente más altas sobre la percepción de la responsabilidad del farmacéutico de involucrarse en varias actividades de atención farmacéutica. Los respondentes que ejercían en una farmacia acreditada puntuaron más alta en la mayoría de las preguntas. Conclusión: Los farmacéuticos de Moldova parecían estar profundamente enraizados en la aproximación tradicional del ejercicio de la farmacia, perteneciendo principalmente al modelo de ejercicio distributivo y, de algún modo, distantes de otros modelos de ejercicio como la atención farmacéutica, la información sobre medicamentos y el auto-cuidado. Palabras clave: Servicios de farmacias comunitarias. Ejercicio profesional. Moldova.
INTRODUCTION The Republic of Moldova is a landlocked country, with about three million inhabitants, in Eastern Europe, located between Romania to the west and Ukraine to the north, east and south. Moldova was formerly part of the Soviet Union and has been a Newly Independent State (NIS) since 1991. It is a densely populated country with about 54% of the population living in rural areas. Moldova has an economy which is in transition and is thus undergoing reform in various sectors including the health and social sectors.1 Initially following independence Moldova inherited the Semashko health care model from the former Soviet Union, having a highly centralized structure with key decision making and planning taking place in the capital.2 The country’s health care system has since been decentralised into a regional (judet) system and since 1993 pharmacies were allowed to become privatised with most being concentrated in towns leaving a number of rural settlements with no/limited access to pharmacy.3 Currently there is a mixed system of state and privately owned pharmacies.2 Official data indicates that there are about 1000 pharmacies putting the pharmacy to population ratio at 1:3000. Pharmacies are licensed and regulated by The Ministry of Health through the National Medicines Agency. The large scale privatization was set in motion following both an economic collapse and a breakdown in the national prescription system, which led to the state having difficulties in ensuring an adequate and regulated drug supply. The privatization system was meant to address these shortcomings.2 This wide spread liberalisation, has however, led pharmacy to be increasingly seen as a part of the commercial sector rather than a part of a professional system within healthcare. In order to improve access to medicines in rural areas, pharmacy outlets - branches of licensed
pharmacies- staffed by pharmacy assistants were granted permission to operate. In addition local hospitals were allowed to open pharmacy outlets, which are, however, staffed by any available health care worker in the area and not by pharmacists or pharmacy assistants. The privatization of this sector has led to a situation whereby medical doctors have been allowed to purchase pharmacies, usually in the clinic or hospital where they work leading to a situation of conflict of interest where expensive or inappropriate drugs are prescribed to increase the pharmacies’ profit margins at the detriment of the 2 patient. While theoretically under the Semashko model patients received unlimited free services, the provision of modern pharmaceuticals was very limited. Currently the spectrum of medicines available has increased, however, access is still a problem due to costs of drugs placing specific patient groups such those with chronic diseases in a difficult situation as they may not afford to purchase their medication leading to inadequate control of their condition. The World Health Organization through the Special Project for Pharmaceuticals in NIS has drawn up and supported the use of a National Essential Drugs List to encourage rational 4 use of drugs in Moldova. As part of the reform in the health sector, under the law on Evaluation and Accreditation in Health Care (2001) a process of accreditation for pharmacies has been set in motion. Pharmacies in Moldova need to be accredited in order to be eligible to enter an agreement with The National Health Insurance Company for drug reimbursement. The accreditation of pharmacies falls under the responsibility of the National Accreditation Council which sets the required standards based on Good Pharmacy Practice Guidelines (GPP) issued by 5 WHO. At present 338 pharmacies have been accredited by the National Accreditation Council. This is envisaged as being a very constructive step which may lead to further positive developments in community pharmacy. There are currently about 3000 pharmacists in Moldova, approximately three quarters of whom are women. Students receive their pharmacy education at the University of Medicine and Pharmacy in Chisinau where they follow a 5 year university course which precedes a 2 year residency programme. Previously the training was modelled under the Soviet system with the course having a 6 very strong emphasis on chemistry. However as part of the reform in education taking place since 1991 the aim is for the training to be in line with European Union norms.7 Since the late 1990’s the pharmacy curriculum has been revised and now includes more practice based subjects such as pharmacotherapy and more recently topics related to social pharmacy and pharmaceutical care have been included. The problems in the pharmaceutical sector during the period of transition have adversely affected the profession of pharmacy with pharmacists having significant difficulties fulfilling their professional aspirations and possibly losing confidence in further
www.pharmacypractice.org
2
Cordina M, Safta V, Ciobanu A, Sautenkova N. An assessment of community pharmacists’ attitudes towards professional practice in the Republic of Moldova. Pharmacy Practice 2008 Jan-Mar;6(1):1-8.
developing their professional role. The aim of the study was therefore to assess community pharmacists’ attitudes towards their professional practice and to determine their perceived competence in various pharmaceutical activities METHODS A questionnaire was mailed to 600 community pharmacists (one in every 5). These pharmacists were randomly selected from a population of 3000 pharmacists. Pharmacists were given a deadline by which to return the completed questionnaires. The questionnaire consisted of 37 questions divided into 6 sections which addressed various aspects of practice. The questionnaire was translated into Romanian and back translated into English by a third party. The sections addressed were managerial activities, dispensing activities, pharmaceutical care activities, inter-professional relationships, public health and competence. For each of the above areas pharmacists were asked to score, on a scale from 0-5 (1= not important, 5=extremely important) the perceived importance of each activity, they were also asked to separately score their perceived competence (0=not competent, 5=extremely competent), in performing each activity. In the case of questions related to pharmaceutical care activities, which have been 8 adapted from a Odedina and Segal , pharmacists were asked to score their degree of agreement or disagreement (0=strongly disagree, 5=strongly agree) as to whether it is the responsibility of the pharmacists to engage in specific pharmaceutical care activities rather than the perceived importance of each activity. In addition respondents were also asked to provide the following demographic information: gender, age, years’ in practice and if they practiced in an accredited pharmacy. The questionnaire was initially piloted on 15 pharmacists through the Association of Pharmacists of the Republic of Moldova. They commented on relevance, clarity and ease of understanding of questions. These comments were taken into consideration in the final draft of the Romanian version. The data was gathered over a 3 month period between December 2006 and February 2007. Data was entered into to SPSS and analysed using Mann-Whitney U tests, Kruskal Wallis. Spearman’s rho correlation was also used. A p value of 50 92 24.9 Practice Experience (years) 1-10 52 14.1 11-20 104 28.1 21-30 132 35.7 >30 82 22.2 Practice in Accredited Pharmacy Yes 260 70.3 No 110 29.7
There was a significant (p
